Extensive cryptococcal tracheitis mimicking lymphoma in an AIDS patient

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) can predispose individuals to opportunistic infections.
• Endobronchial infections, particularly in the trachea, are uncommon and can mimic neoplastic processes.
• Distinguishing between infection and malignancy in the airways can be challenging, impacting patient management.

Purpose of the Study:

• To present a rare case of extensive cryptococcal tracheitis in an HIV/AIDS patient.
• To illustrate the diagnostic challenges posed by radiologic findings that can be confused with non-Hodgkin's B-cell lymphoma.
• To emphasize the importance of definitive tissue sampling in diagnosing endobronchial conditions.

Main Methods:

• Case report of a 35-year-old male with HIV/AIDS.
• Review of radiologic imaging, including positron emission tomography (PET) with 18-fluoro-2-deoxyglucose (FDG).
• Flexible bronchoscopy with tissue sampling for histopathological analysis.

Main Results:

• Radiologic findings suggested an infiltrative process with tracheal involvement and increased FDG uptake, suspicious for non-Hodgkin's B-cell lymphoma.
• Flexible bronchoscopy and tissue sampling confirmed extensive cryptococcal infection of the trachea (cryptococcal tracheitis).
• The case highlights the difficulty in radiologically differentiating this rare endobronchial fungal infection from malignancy.

Conclusions:

• Cryptococcal tracheitis is an extremely rare manifestation of endobronchial cryptococcosis.
• Radiologic imaging can be misleading, necessitating invasive procedures for accurate diagnosis.
• Early and accurate diagnosis is crucial for appropriate treatment of opportunistic infections in immunocompromised patients.